Summary
Patients or their relatives used specific phrases to express a gut feeling, indicating that they trust or do not trust the situation or perceive changes in normal, familiar patterns. Their gut feelings mostly involved a sense of alarm. Participants with a sense of alarm were convinced that something was wrong and they, particularly mothers of sick children, had often learned to trust this gut feeling. They took gut feelings about their child’s health very seriously and mentioned that they acted on them more swiftly than on gut feelings regarding their own health. When patients or their relatives could not explain symptoms, their uncertainty and anxiety increased, and they felt they were losing control. In general, a gut feeling was a reason to contact their GP to clarify the health situation, or to be reassured. Patients were less inclined to share their gut feelings with triage or practice nurses than with GPs.
Patients usually felt that primary care professionals took their gut feelings seriously.
Strengths and limitations
To date, this is the first study exploring what phrases and expressions patients and their relatives use to voice their gut feelings, and how they share them with primary care professionals. This study included patients from the Netherlands and Belgium. The way in which patients voiced their gut feelings did not differ between participants in the two countries. It is unlikely that patients in other countries will have a different concept of gut feelings. They may use related phrases in the idiom of their language but may differ in the ways that they share their gut feelings with primary care professionals.
Fewer Belgian patients were included in the study. The interviews with the Belgian patients contained virtually no new information relating to the research questions from that of the interviews with the Dutch patients. This finding is in line with previous research results.11 For this reason, it was decided to stop the inclusion of any further Belgian patients.
Most members of the research team are GPs, which might have caused a limited perspective on the topic. For this reason, the input of a cognitive psychologist in the team was valuable.
Comparison with existing literature
In a previous study that examined how patients perceived the role of GPs’ gut feelings in clinical decision making, some patients described their own gut feeling as ‘something is wrong’.25 They explained that their gut feeling was based on the knowledge of their body and what was normal for them. This gut feeling led to action in the form of seeking medical help. If there was mutual trust, patients mentioned their gut feeling in the consultation. These findings are in line with the results of the current study. This previous study also found that patients’ impressions of the way GPs used their own gut feelings in clinical decision making were similar to those reported by GPs.25
Some Belgian patients in the current study seemed to be more reticent about informing their GP of their gut feelings than Dutch patients. This might be explained by cultural differences as similar differences were found in an earlier study that explored healthcare professionals’ understanding of patients’ gut feelings.11 Like the current study, this previous study found no misunderstandings between GPs and patients about the notion of gut feelings.11 GPs indicated that they easily recognise patients’ gut feelings and consider them a useful contribution to their clinical reasoning and a better understanding of the patient’s problem.11
The process of developing gut feelings does not differ between GPs and patients, but the underlying knowledge and expertise does. GPs’ gut feelings are based on medical knowledge and specific expertise, while patients’ gut feelings are based on experiential knowledge about their own health and body, and may signal any changes.1,26 GPs’ and patients’ gut feelings are both drivers of action, such as formulating and weighing up hypotheses with a serious outcome, and calling their GP or the out-of-hours GP service, respectively.
A five-item degree-of-worry scale used in research in Denmark measures a mix of patients’ worry and gut feelings.13,14 The first three items ask about worry and concern, whereas the last two items describe gut feelings using phrases such as ‘a sense of urgency’, ‘a feeling of distress’, ‘the certainty that something was wrong’, and ‘a feeling of threat’. In the authors’ view, however, worry and gut feelings are different concepts. In situations where there is a clear cause, such as after a serious accident, there will be a high degree of worry or concern about the health consequences, but this will usually not lead to a gut feeling. However, in uncertain situations of illness with, in the patient’s view, unclear causes and consequences, patients might say, ‘there is something wrong with me’ or ‘it’s different from normal’, expressing their intuitive sense of alarm, which may then lead to worry or concern. Worry or concern is not based on an automatic, intuitive knowing, as is the case with a sense of alarm, but can be traced back to reasonable arguments. When composing a questionnaire for patients about their gut feelings, the difference between worry/concern and gut feelings should, therefore, be taken into account.
A GP’s sense of alarm means that the physician perceives an uneasy, intuitive feeling as they are concerned about a possible adverse outcome.3 It is a sense of ‘there’s something wrong here’, although specific indications have not yet been found, and this gut feeling makes the GP worried about a patient’s health situation. There is a need to initiate further diagnostics and maybe also immediate management to prevent serious health problems. However, a GP might worry about the course of the patient’s illness, for example, in the case of a patient with known serious heart failure, but still experience a sense of reassurance in the background. The physician knows how to manage the situation, for example, by prescribing effective medicines. The degree-of-worry scale described above mixes up worry/concern and gut feelings.13,14 In the authors’ questionnaire for GPs about their gut feelings,4 therefore, the word worry is only used in one item, in which the gut feeling is described as ‘something does not add up’.
